Vasectomy: The US men embracing permanent birth control

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In the US, some young men report that legal changes to reproductive rights have catalysed them to opt for vasectomies.

Kate Morgan

On a Friday in January, Lyon Lenk will go to his urologist’s office in Kansas City, Missouri, US. He’ll be given a local anaesthetic, and the doctor will cut a tiny incision in Lenk’s scrotum, locate his vas deferens – the tube that carries sperm through the penis – cut it, and seal the ends. The incision will be closed, and Lenk will go home, take some over-the-counter painkillers and as long as there are no complications, be free from discomfort within a week or so.

Lenk, 35, and his partner have no children, and want to keep it that way. When the United States Supreme Court ruled in Dobbs v Jackson Women’s Health Organization that there is no constitutional right to an abortion – overturning Roe v Wade, the decision that protected abortion rights since 1973 – he scheduled a vasectomy.

“I think like a lot of people in my situation, this is something that we were probably on the fence about before Roe v Wade got overturned,” says Lenk. “But this is the only option to keep my partner safe at this juncture, because I live in Missouri. And Missouri had one of the ‘trigger laws’ that went into effect, [criminalising abortion] right as it got overturned. It just got really scary and really real all at once.”

More young men are inquiring about and getting vasectomies. It’s a trend that’s been observed informally in several countries, and has particularly spiked in the United States since the Supreme Court’s decision. Google Trends tracked a huge uptick in US searches for ‘vasectomy’, along with the related search terms “Roe” and “abortion”; search volume was even higher in places with trigger laws. A report from telehealth research company Innerbody Research showed searches for “where can I get a vasectomy” increased by 850% in the days after the news, with the biggest jumps in conservative states Texas and Florida. One practice in Florida told CBS News that the number of child-free men getting vasectomies under the age of 30 had doubled since the ruling. Urologists in New York, California, Iowa and elsewhere have reported similar upticks.

It’s a norm-bucking trend. Responsibility for birth control, even for long-term couples, has long fallen disproportionately to women; female sterilisation, oral contraceptives, IUDs and other options for women remain the most common forms of birth control in the US. But with more Americans focusing on contraceptive decisions in the wake of the Dobbs ruling, the rise in interest around vasectomies may signal a shift towards men taking more responsibility for their own reproduction – or lack thereof.

‘Fear is a real factor’

In many countries, vasectomy has been a niche practice. Rates are especially low in developing nations, with average prevalence (usage by women aged 15 to 49 in relationships as a form of contraception) between 0% and 2%. It’s more common in other countries: UN figures from 2015 show that in Canada and the UK, prevalence stood at 21.7% and 21%, respectively. In the US, the UN figure was 10.8%.  

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While vasectomies in American men between 18 and 45 were on the decline between 2002 and 2017, studies have documented some notable spikes, especially during the 2007 to 2009 Great Recession. “A 34% increase in vasectomy utilization during the Great Recession … was most strongly correlated with the rise in unemployment rate,” wrote researchers in the Department of Urology at Stanford University.

Economic conditions are not the only factor in vasectomy upticks. Concerns linked to climate and overpopulation have led to a desire, for some, to limit their family size or have no children. In Australia, where vasectomy rates are relatively high compared to some developed nations, doctors are reporting an increase in men younger than 30 seeking the procedure. Between 2020 and 2021, “there’s been close to a 20% increase in the number of childless men under 30 requesting vasectomies”, a doctor in Australia told SBS News. There are also anecdotal reports that vasectomies among young men are becoming more prevalent in the UK and even in China, where sterilisation remains culturally taboo.

In the US, says Alexander Pastuszak, assistant professor in the division of urology surgery at the University of Utah, the most common reason for seeking a vasectomy used to be “my wife asked me to”. But since the Supreme Court’s decision, he says, more men seem to be taking ownership of their reproductive options, as women’s options become more limited. “Particularly in the states where the anti-abortion laws have really been reinstated, my colleagues have definitely seen an uptick in the number of men coming to see them for vasectomy,” says Pastuszak. “There’s a sense that, you know, we can’t just have sex anymore on our terms.”

Stanton Honig, professor of clinical urology and division chief of reproductive and sexual medicine at Yale School of Medicine, also believes the political climate is a driving factor in the rising number of vasectomies. “We did see an initial spike in quotes for vasectomy with the overturn of Roe v Wade,” he says. “Many urologists are now backed up months to do vasectomies.”

The flurry of calls has died down a bit in his office, says Honig, though his calendar is still full. “But in the red states – I have a friend in Kansas who has told me that this has continued to rise. It’s the same in Wisconsin. I think there is still fear – that is a real factor. I don’t think it’s something that people weren’t thinking about before, but in talking to patients, it’s clear this kind of pushed them to the edge.”

Keith Laue, a 23-year-old content creator from Austin, Texas, US, says he had the procedure done because he believes that women shouldn’t have to shoulder the burden of birth control alone. “Texas has been less than kind to women’s reproductive rights, to put it lightly,” he says. Laue and his partner have a three-year-old daughter, and are sure they don’t want any more children. After talking to his partner about her “really rough” experience with contraceptives, Laue says it was an easy decision that he should be the one to take responsibility for the couple’s birth control.

Laue made the decision to get a vasectomy last year, after Texas passed the “heartbeat bill” banning abortion after six weeks. “I put off actually booking the appointment,” he says, “but when the Roe decision was leaked, that was when I was like ‘Oh, I’ve got to actually do this now’. That’s when I scheduled my appointment.”

Honig suggests fear that other forms of birth control could be at risk from subsequent reproductive rights legislation could be feeding into the US rise in vasectomies. “You know, it’s a slippery slope,” says Honig. “Especially in states like Ohio, Indiana, Missouri where, once Roe v Wade was overturned, they went back to abortion not being legal, there was a fear that perhaps soon they couldn’t get any type of family planning.”

That eventuality, says Lenk, “crossed my mind pretty immediately”. It’s part of what motivated him to schedule a vasectomy while he still could. To date, he says, responsibility for contraception has fallen on his partner, which has come with challenges. “She struggles with hormonal birth control,” he says. “It causes a whole bunch of side effects, but she still takes it.  It interferes with her moods, and other medications that she takes, and IUDs are not ideal for her either.” Sparing his partner the discomfort of these options was another motivator for Lenk. 

Meaningful shift or short-term spike?

Despite the apparent advantages of the procedure, the number of men having vasectomies has traditionally been low in the US, largely because of the accepted norm that contraception is women’s responsibility, says Krystale Littlejohn, an associate professor of sociology at the University of Oregon. She cautions that even this recent increase must be put into context.

“The burden has heavily fallen on women and people who get pregnant for decades,” she says. “And still, at least one in four women in the United States of reproductive age is going to have a tubal ligation. Compare that 25% to the low, low rate of vasectomy. We see these spikes, but what does that look like when the number was so low in the first place?” 

The increase in the number of vasectomies in the wake of Roe v Wade’s overturn is, however, notable, says Littlejohn. Some men are stepping up, whether out of concern for their partners, fear of having kids they don’t want, as a political statement against abortion restriction or a combination of all three. But there’s a chance it’s more of a short-term, reactive trend.

“I think it’s wonderful that they’re doing it,” say Littlejohn. “I think it will contribute to things being a bit better for women and people who get pregnant, but I just don’t think it’s going to be the sea change in responsibility that some observers believe. Sometimes, like with lots of other things that happen around crises in our society, you can have an uptick in interest as soon as something happens. But it has to be sustained for us to see actual change.”

Pastuszak, on the other hand, sees the recent spike in vasectomies as more than a flash in the pan. “The Dobbs decision was really sort of a watershed moment for this,” he says. “I suspect that there’s going to be an increase over the coming few years, as long as this legislation holds.”

The Dobbs decision has forced some people to examine the potential ramifications of unwanted pregnancy for women, especially in right-leaning states. In a post-Roe America, some lawmakers are calling for legislation preventing women travelling to other states for legal abortions. That means women could face being charged with a crime for having a legal abortion, risking their health if they have one illegally or being forced to continue with an unwanted pregnancy. The threat of those consequences is what triggered Laue to get the vasectomy procedure, an act he sees as – at least in part – a political statement.

“Following the overturning of Roe v Wade, I’m way more confident in this decision than ever,” says Laue. “I think that as men it’s time that we start to support women and support our weight of birth control.”

While that’s a positive, helpful message, Littlejohn says real societal change will require a different line of thinking. “As long as we see this as something that men are doing to ‘lend a hand to their partners’ and being noble, in service of their partners’ not being able to prevent pregnancy,” she says, it perpetuates a narrative that men aren’t the default responsible party for contraception. 

To see a true systemic shift, the thinking must become, simply, “men have a role in preventing pregnancy”, continues Littlejohn, “versus now is the time for men to take responsibility, because there’s a threat to abortion and birth control methods for their partners. If we want to see that change, then we really have to focus on promoting the idea that regardless of what happens with birth control for women, men have a responsibility.”

Pastuszak hopes the spike in vasectomies will translate to an increased interest in male birth control in general, something that will push research around hormonal and non-hormonal options for men forward. “What we’re seeing is a high demand, especially amongst younger men, for contraceptive options,” he says. “That doesn’t mean permanent options. It means more guys are interested in exploring and potentially engaging, in contraceptive approaches. Those are the types of things that I think we can look forward to in the next five-to-10 years. And that will truly allow the reproductive freedom that younger men, especially, are looking for.”

Both Laue and Lenk say scheduling the procedure was a straightforward experience. Both were given information about the fact that vasectomies are considered permanent. While reversal is possible, it lowers the rate of successful pregnancy down the line. “The only questions [my doctor] asked were about my seriousness,” says Laue. The urologist asked if he had any children. “He was like, ‘do you want to have any more?’ When I said no, that was like the end of the questioning on that line.”

For Lenk, getting a vasectomy feels both like protecting himself and his partner, and simply taking responsibility for his own behaviour. It’s not a decision he’s taken lightly, but he’s very certain it’s the right one. “It’s taken a lot more thought and time and talks with my partner than maybe I initially expected, but it’s all been very much worth it. My partner and I have only grown closer together, and I’m getting plenty of support from my family and my friends.”

Lenk hopes that more men start to think about their role in the reproductive process. “I feel like two decades ago we were talking about male birth control, and I’ve been waiting ever since and that’s never come to pass,” he says. “Now, we’re kind of left with this imperfect surgical solution, but it’s what I need to do.”

BBC

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